Abstracts

Rationale: Children in convulsive RSE are often treated with continuous intravenous infusions (CI). We examined escalation to CI and challenge the hypothesis that RSE that fails to respond to 2 antiepileptic drugs (AEDs) always requires escalation to CI.Methods: A prospective cohort study of pediatric RSE in 9 tertiary pediatric hospitals in the US from June 2011 to June 2013 including children 1 month to 21 years with initial convulsive seizures and failure of ≥2 AEDs to stop seizures or the initiation of CI. Exclusions: Non-convulsive SE on EEG without initial convulsive seizures or non-convulsive SE with motor manifestations limited to infrequent myoclonic jerks. Each center followed its own procedure for management of RSE. Data included first- and second-tier AEDs and use of CI. Seizures were dichotomized into continuous or intermittent. A stratification of in-hospital SE >30-mins was used for comparative analyses.Results: Of 111 cases of RSE in 111 patients, 55 (49.5%) received CI therapy. There was no difference in age, sex distribution, ethnicity or known epilepsy of patients receiving CI compared to those receiving AED boluses. All patients were admitted to a PICU and remained for 3 [2 – 12] days (median [interquartile range]). SE started out-of-hospital in 38/55 (69%) cases that went on to receive CI treatment; this proportion was no different to those who received boluses of AEDs (36/56 65%). Duration of convulsive seizures in all patients was 141 [70 – 357.5] mins. Overall, there was no difference in duration comparing those receiving CI to those receiving AED boluses (162 [70 – 1200] vs 123.5 [70 – 240] mins). There were 95/111 (85.6%) cases with a duration of SE >30-mins in-hospital. Of these, the interval to seizure cessation was longer in the 45 receiving a CI as compared to the 50 cases with AED boluses: 155 [119.3-460] vs 110.5 [54-217] mins (P<0.01). Hypotension and the use of vasopressors were more frequent in CI therapy (CI vs non-CI: hypotension19/45 vs 8/50, P<0.01; vasopressors 15/45 vs 3/50, P<0.001). PICU length of stay was increased in those receiving CI therapy (CI vs non-CI: 10 [3-19] vs 2 [2-3] days, P<0.001), despite no difference in the proportion mechanically ventilated (CI vs non-CI: 37/45 vs 35/50). Overall, continuous SE was present in 34/110 (31%). In the 25 cases with in-hospital RSE >